Topics in Geriatrics:Aerobic exercise is often recommended for aging individuals, but will it improve their memory? It has been proposed that aerobic exercise causes changes within the brain that can increase volume in the elderly, and therefore memory and cognitive function. If this is true, we can teach our elderly patients that aerobic exercise isn’t just good for them physically and emotionally, but also cognitively. It may not only help them think more clearly, but increase their brain volumes in a way that wards off cognitive impairment and the normal memory loss that can occur with aging.
Learning Objectives:
Understanding if there is an impact of exercise on brain volume, especially in the aging adult.
If there are changes in brain volume with exercise, determining if there are corresponding improvements in memory and cognition.
Figuring out how we use these findings and teach our elderly patients about these changes and the potential personal benefits for their own lives in a way that is most motivating.
Information About the Topic:
Many times, especially with our elderly patients, patients do not understand why we are asking them to do certain things. Unfortunately, many individuals feel like issues with being “old” are normal. Many of these issues revolve around memory. A little memory loss is considered normal when you have wrinkles and grey hair. However, it does not have to be. While it is true that memory begins to decline between 40 and 70 up to 18%, these changes are extremely variable and do not have to be as dramatic.1 It is well established that brain volumes diminish with age, especially in pathologies that target memory, such as Alzhiemer’s Disease. In theory, if we can slow central nervous system atrophy, we could possibly slow memory loss as well. There are many studies coming out examining whether or not aerobic exercise has the potential to increase brain volumes in aging patients. Many of our patients, as well as fellow physical therapists, believe exercise is going to improve balance, decrease fall risk, improve cardiovascular health, and decrease osteoporosis, just to name a few. It is reasonable to think that any impact on brain function may be a secondary result to this. For example, reducing fall risk will prevent elderly from falling and hitting their heads causing memory loss as a side effect of injury. Or, exercise will help manage blood sugar levels that will in turn reduce any cognitive fog an elderly individual may be experiencing. Also, increasing cardiovascular health will reduce the chances of a CVA that could cause vascular dementia. These are all true and well established ways that exercise can improve memory and cognitive function.1 It has been proposed that aerobic exercise can increase brain volumes, improving memory as a primary benefit. Even though many elderly patients accept memory loss as a normal part of aging, it is often one of the most terrifying aspects of getting older. Memory is related to independence, and no one is willing to hand over the keys to their car, managing their money, or having to get help with every-day tasks. If we can prove and find a way to explain to patients that aerobic exercise will truly make their brains bigger and healthier, it could possibly provide the motivation that many of these individuals need to stay healthy cognitively and in all the other ways exercise can benefit them.
Who should you use aerobic exercise with to increase brain volume/memory?
The simple answer is, everyone. No matter what their age or condition is, exercise is an important part of life. However, we are examining exercise in older adults, or adults on their way to becoming older, in order to reduce the impacts of memory loss by increasing brain volumes. Surprisingly, the aerobic exercise guidelines remain about the same once they are over 65 years of age. Current ACSM guidelines for aerobic exercise in elderly populations is moderate-intensity exercise for at least 30 minutes a day, 5 days a week. If vigorous activity is being performed, about 20 minutes 3 times a week is sufficient. A combination of vigorous-intensity and moderate-intensity aerobic exercise is encouraged. The big considerations for exercise in the aging population is to make sure pre-morbid conditions are taken into account when starting an exercise program. Also, balance and flexibility are encouraged.6 As these current guidelines reflect, exercise is just as important, if not even more so, in the elderly population. It is important to have these literature-based recommendations ready to give this population to encourage compliance with an exercise plan. It is also important to make sure once they are ready to start, the exercise program is started slowly with appropriately timed warm-up and cool-down periods.6 Exercise is great at any age for many of the reasons listed earlier. However, as mentioned before, because normal memory loss can start in a significant way after the age of 40, it is especially important to encourage our patients to exercise with this in mind starting at an early age. One of the most important and encouraging findings is that normal memory loss from aging is variable. This means patients may have an impact on how much memory loss happens.
Evidence for Aerobic Exercise Improving Memory and Cognitive Function in Elderly:
There is a lot of research on this topic in the literature, and this first study, by Colcombe et al, examined 59 healthy, inactive individuals that ranged from 60-79. Using MRI, significant increases in grey and white matter were found in the aerobic exercise group, but not in a group just performing stretches and toning exercises. The conclusions of this study were that aerobic fitness is associated with sparing of brain tissue in older adults. Unfortunately, this study alone does not determine whether or not these increases of brain volumes are directly linked with increases in cognitive function and memory.2 The Hippocampus shrinks as we age, which leads to memory loss and increased risk of dementia. Erikson et al, in 2009, proposed that if we know what causes normal hippocampal decay in the aging brain without dementia, we can promote lifestyle changes to reduce this atrophy from taking place. Based on other studies, they believed that aerobic exercise was very effective at reducing cortical atrophy, but no research had been explicitly performed on determining if aerobic exercise had any impact on hippocampal decay. This is very important because the hippocampus is largely responsible for memory. Looking specifically at hippocampal volumes using MRI in 165 individuals, some performing aerobic exercise and other who were not, they found that aerobic fitness was significantly associated with increases in hippocampal volume in older adults. This study, unlike the last, can say that aerobic exercise increases memory (or reduces memory loss) by reducing hippocampal decay because the hippocampus is directly responsible for memory.3 In 2011, Erikson et al did a continuation of the previous study, looking specifically at the anterior hippocampus, which is related to spatial memory, in older adults. They performed a RCT with 120 older adults examining the impact of an aerobic training program. The experimental groups were placed into a moderate-intensity aerobic exercise program 3 days a week and compared to other individuals that just performed stretching and toning exercises. Both groups performed their respective programs for one year. The researchers examined hippocampal volumes using MRI and found that the aerobic exercise group had a 2% increase in hippocampal volume, which effectively reversed age-related loss by 1-2 years. These findings continue the significant findings of the previous study: aerobic exercise reverses memory loss in the aging population.4 An interesting question arises from these finding, however. What causes the reversal of atrophy in the hippocampus of aging adults? A study by Thomas et al examined the cause of this increase in hippocampal volume. Others studies had proposed that these improvements came from increases in vasculature. This study found it to be an increase in myelination. These authors also found that these findings were only temporary. Once stopping an aerobic fitness training program, older individuals returned to baseline hippocampal volumes within 6 weeks.6 This is an extremely important finding because it shows how quickly brain plasticity occurs and that older adults cannot afford to stop physical activity, even for a short period of time. This would be a wonderful study to use with patients to motivate them to keep going with their aerobic exercise programs. This next study by Hendin et al examined the impact of an aerobic exercise program on overall cognitive function and executive planning. Their findings build on the research that aerobic exercise does increase brain volumes, but they also found that there is an increase in connectivity between regions of the brain in the aging adult with aerobic exercise. One of the most important take away messages is that the length of training is important to the effects that are gained. More neuroplasticity, connectivity, and volume increases are found with longer duration aerobic exercise programs. This is vital information to give our patients because we can encourage them the longer they are in an exercise program, the better their memory and cognitive function will be.7 To conclude, it is very evident while looking at recent research that aerobic exercise not only increases brain volume, but can directly increase memory by reducing atrophy in the hippocampus. Furthermore, exercise increases the connectivity of the brain, improving overall cognitive function. We should be able to explain to our patients that these improvements will actually have a significant impact on their quality of life by improving their memory. To encourage them to be compliant to an aerobic exercise training program, we can present the research that suggests even after 6 weeks of stopping exercise, they can return back to baseline memory and lose any increase in memory they had found. Other encouragement can come from the fact that the longer they remain in an aerobic training program, the better they will get. Therefore, they should start now.
References: 1.Cognitive Impairment. The Division of Geriatric Medicine at Saint Louis University. VA VISN 15 GRECC. 2.Colcombe, Stanley J., et al. "Aerobic exercise training increases brain volume in aging humans." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61.11 (2006): 1166-1170. 3. Erickson, Kirk I., et al. "Aerobic fitness is associated with hippocampal volume in elderly humans." Hippocampus 19.10 (2009): 1030-1039.
4.Erickson, Kirk I., et al. "Exercise training increases size of hippocampus and improves memory." Proceedings of the National Academy of Sciences 108.7 (2011): 3017-3022. 5.Nelson, Miriam E., et al. "Physical activity and public health in older adults. Recommendation from the American College of Sports Medicine and the American Heart Association." Circulation (2007). 6.Thomas, Adam G., et al. "Multi-modal characterization of rapid anterior hippocampal volume increase associated with aerobic exercise." Neuroimage 131 (2016): 162-170. 7.Voss, Michelle W., et al. "Plasticity of brain networks in a randomized intervention trial of exercise training in older adults." Frontiers in aging neuroscience 2 (2010): 32
Topics in Geriatrics:Aerobic exercise is often recommended for aging individuals, but will it improve their memory? It has been proposed that aerobic exercise causes changes within the brain that can increase volume in the elderly, and therefore memory and cognitive function. If this is true, we can teach our elderly patients that aerobic exercise isn’t just good for them physically and emotionally, but also cognitively. It may not only help them think more clearly, but increase their brain volumes in a way that wards off cognitive impairment and the normal memory loss that can occur with aging.
Learning Objectives:
Information About the Topic:
Many times, especially with our elderly patients, patients do not understand why we are asking them to do certain things. Unfortunately, many individuals feel like issues with being “old” are normal. Many of these issues revolve around memory. A little memory loss is considered normal when you have wrinkles and grey hair. However, it does not have to be. While it is true that memory begins to decline between 40 and 70 up to 18%, these changes are extremely variable and do not have to be as dramatic.1 It is well established that brain volumes diminish with age, especially in pathologies that target memory, such as Alzhiemer’s Disease. In theory, if we can slow central nervous system atrophy, we could possibly slow memory loss as well. There are many studies coming out examining whether or not aerobic exercise has the potential to increase brain volumes in aging patients.
Many of our patients, as well as fellow physical therapists, believe exercise is going to improve balance, decrease fall risk, improve cardiovascular health, and decrease osteoporosis, just to name a few. It is reasonable to think that any impact on brain function may be a secondary result to this. For example, reducing fall risk will prevent elderly from falling and hitting their heads causing memory loss as a side effect of injury. Or, exercise will help manage blood sugar levels that will in turn reduce any cognitive fog an elderly individual may be experiencing. Also, increasing cardiovascular health will reduce the chances of a CVA that could cause vascular dementia. These are all true and well established ways that exercise can improve memory and cognitive function.1
It has been proposed that aerobic exercise can increase brain volumes, improving memory as a primary benefit. Even though many elderly patients accept memory loss as a normal part of aging, it is often one of the most terrifying aspects of getting older. Memory is related to independence, and no one is willing to hand over the keys to their car, managing their money, or having to get help with every-day tasks. If we can prove and find a way to explain to patients that aerobic exercise will truly make their brains bigger and healthier, it could possibly provide the motivation that many of these individuals need to stay healthy cognitively and in all the other ways exercise can benefit them.
Who should you use aerobic exercise with to increase brain volume/memory?
The simple answer is, everyone. No matter what their age or condition is, exercise is an important part of life. However, we are examining exercise in older adults, or adults on their way to becoming older, in order to reduce the impacts of memory loss by increasing brain volumes. Surprisingly, the aerobic exercise guidelines remain about the same once they are over 65 years of age. Current ACSM guidelines for aerobic exercise in elderly populations is moderate-intensity exercise for at least 30 minutes a day, 5 days a week. If vigorous activity is being performed, about 20 minutes 3 times a week is sufficient. A combination of vigorous-intensity and moderate-intensity aerobic exercise is encouraged. The big considerations for exercise in the aging population is to make sure pre-morbid conditions are taken into account when starting an exercise program. Also, balance and flexibility are encouraged.6 As these current guidelines reflect, exercise is just as important, if not even more so, in the elderly population. It is important to have these literature-based recommendations ready to give this population to encourage compliance with an exercise plan. It is also important to make sure once they are ready to start, the exercise program is started slowly with appropriately timed warm-up and cool-down periods.6
Exercise is great at any age for many of the reasons listed earlier. However, as mentioned before, because normal memory loss can start in a significant way after the age of 40, it is especially important to encourage our patients to exercise with this in mind starting at an early age. One of the most important and encouraging findings is that normal memory loss from aging is variable. This means patients may have an impact on how much memory loss happens.
Evidence for Aerobic Exercise Improving Memory and Cognitive Function in Elderly:
There is a lot of research on this topic in the literature, and this first study, by Colcombe et al, examined 59 healthy, inactive individuals that ranged from 60-79. Using MRI, significant increases in grey and white matter were found in the aerobic exercise group, but not in a group just performing stretches and toning exercises. The conclusions of this study were that aerobic fitness is associated with sparing of brain tissue in older adults. Unfortunately, this study alone does not determine whether or not these increases of brain volumes are directly linked with increases in cognitive function and memory.2
The Hippocampus shrinks as we age, which leads to memory loss and increased risk of dementia. Erikson et al, in 2009, proposed that if we know what causes normal hippocampal decay in the aging brain without dementia, we can promote lifestyle changes to reduce this atrophy from taking place. Based on other studies, they believed that aerobic exercise was very effective at reducing cortical atrophy, but no research had been explicitly performed on determining if aerobic exercise had any impact on hippocampal decay. This is very important because the hippocampus is largely responsible for memory. Looking specifically at hippocampal volumes using MRI in 165 individuals, some performing aerobic exercise and other who were not, they found that aerobic fitness was significantly associated with increases in hippocampal volume in older adults. This study, unlike the last, can say that aerobic exercise increases memory (or reduces memory loss) by reducing hippocampal decay because the hippocampus is directly responsible for memory.3
In 2011, Erikson et al did a continuation of the previous study, looking specifically at the anterior hippocampus, which is related to spatial memory, in older adults. They performed a RCT with 120 older adults examining the impact of an aerobic training program. The experimental groups were placed into a moderate-intensity aerobic exercise program 3 days a week and compared to other individuals that just performed stretching and toning exercises. Both groups performed their respective programs for one year. The researchers examined hippocampal volumes using MRI and found that the aerobic exercise group had a 2% increase in hippocampal volume, which effectively reversed age-related loss by 1-2 years. These findings continue the significant findings of the previous study: aerobic exercise reverses memory loss in the aging population.4
An interesting question arises from these finding, however. What causes the reversal of atrophy in the hippocampus of aging adults? A study by Thomas et al examined the cause of this increase in hippocampal volume. Others studies had proposed that these improvements came from increases in vasculature. This study found it to be an increase in myelination. These authors also found that these findings were only temporary. Once stopping an aerobic fitness training program, older individuals returned to baseline hippocampal volumes within 6 weeks.6 This is an extremely important finding because it shows how quickly brain plasticity occurs and that older adults cannot afford to stop physical activity, even for a short period of time. This would be a wonderful study to use with patients to motivate them to keep going with their aerobic exercise programs.
This next study by Hendin et al examined the impact of an aerobic exercise program on overall cognitive function and executive planning. Their findings build on the research that aerobic exercise does increase brain volumes, but they also found that there is an increase in connectivity between regions of the brain in the aging adult with aerobic exercise. One of the most important take away messages is that the length of training is important to the effects that are gained. More neuroplasticity, connectivity, and volume increases are found with longer duration aerobic exercise programs. This is vital information to give our patients because we can encourage them the longer they are in an exercise program, the better their memory and cognitive function will be.7
To conclude, it is very evident while looking at recent research that aerobic exercise not only increases brain volume, but can directly increase memory by reducing atrophy in the hippocampus. Furthermore, exercise increases the connectivity of the brain, improving overall cognitive function. We should be able to explain to our patients that these improvements will actually have a significant impact on their quality of life by improving their memory. To encourage them to be compliant to an aerobic exercise training program, we can present the research that suggests even after 6 weeks of stopping exercise, they can return back to baseline memory and lose any increase in memory they had found. Other encouragement can come from the fact that the longer they remain in an aerobic training program, the better they will get. Therefore, they should start now.
References:
1. Cognitive Impairment. The Division of Geriatric Medicine at Saint Louis University. VA VISN 15 GRECC.
2. Colcombe, Stanley J., et al. "Aerobic exercise training increases brain volume in aging humans." The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61.11 (2006): 1166-1170.
3. Erickson, Kirk I., et al. "Aerobic fitness is associated with hippocampal volume in elderly humans." Hippocampus 19.10 (2009): 1030-1039.
4. Erickson, Kirk I., et al. "Exercise training increases size of hippocampus and improves memory." Proceedings of the National Academy of Sciences 108.7 (2011): 3017-3022.
5. Nelson, Miriam E., et al. "Physical activity and public health in older adults. Recommendation from the American College of Sports Medicine and the American Heart Association." Circulation (2007).
6. Thomas, Adam G., et al. "Multi-modal characterization of rapid anterior hippocampal volume increase associated with aerobic exercise." Neuroimage 131 (2016): 162-170.
7. Voss, Michelle W., et al. "Plasticity of brain networks in a randomized intervention trial of exercise training in older adults." Frontiers in aging neuroscience 2 (2010): 32